Pulmonary and Critical Care Fellowship Program

Education and Training

About the Program

Welcome to the Pulmonary and Critical Care Medicine Fellowship at The Ohio State University Wexner Medical Center. We appreciate your interest in our program, and invite you to take a look around to learn a little more about us.

One of the major goals of the Division of Pulmonary, Critical Care and Sleep Medicine is to prepare physicians for careers in academic medicine. The overall goal of our fellowship is to provide fellows with a complete well-rounded training program designed to enhance their clinical skills, scientific knowledge and provide the tools necessary to develop their research skills.

A strength of our fellowship training program is the balance we provide in terms of clinical training, research opportunities and our educational curriculum.

Clinical Experience

Clinical Experience

The fellowship program consists of a minimum of 18 months of clinical exposure, the majority of which occurs during the first year. We have a large and diverse patient population and currently have eight core clinical rotations per month. In addition to these rotations, F2s rotate with the surgical critical care team and F3s rotate with the thoracic surgical critical care team and the neurologic critical care team.

Night call is fulfilled via a night float rotation. When not on night float, fellows have no overnight call responsibilities. F1s do approximately two weeks of night float, F2s four weeks and F3s four weeks. Two fellows split a four-week block of night float and when not on service, that block the fellow has no clinical responsibilities except for his or her own continuity clinic. Night float and all clinical rotations are structured to comply with ACGME duty hour guidelines.

Sub-Subspecialty Programs Both patient care and research components

Asthma

COPD

Cystic fibrosis (adult)

Interstitial lung disease

Interventional pulmonology

Lung cancer

Pulmonary hypertension

Pulmonary transplantation

Sarcoidosis

Sleep medicine

Tuberculosis

Surgical critical care

Thoracic surgery critical care

Cardiovascular surgery critical care

Neurologic critical care

First Year (Clinical Year)

The first year fellow is exposed to the entire spectrum of pulmonary and critical care illnesses through time spent at OSU University Hospital on the medical intensive care unit (MICU) service; at University Hospital, James Cancer Hospital and Ross Heart Hospital on the pulmonary consult services and transplant service; and at OSU East Hospital on the pulmonary and critical care consult service.

The fellow will rotate among the core service rotations and each fellow will spend approximately the same amount of time on the various rotations. In addition, first year fellows also spend two weeks in the sleep medicine clinics.

Pulmonary medical school

A unique feature of our fellowship is that we have a month-long orientation program in July of F1 year developed by our program director, which we call Pulmonary Medical School.

No first year fellow takes any call in July and they are not formally assigned to a service.

First year fellows spend July:

Reviewing the basics of pulmonary physiology

Learning basics of pulmonary and critical care medicine

Spending time in our simulator lab with interactive sessions aimed at mastering the basics of bronchoscopy, airway management, chest tubes and other essential procedures

When not in class or in the simulator lab (half day most days), F1s spend time on the core rotations learning the specific requirements of each rotation and fully participating in the care of the patients.

The goal of this month is to allow the first year fellows to review the basics of pulmonary and critical care physiology and clinical medicine, begin to learn the essential procedural skills required of a pulmonologist and get acclimated to the hospital or program before being placed on service or on call.

Second and Third Years

During the second and third years, the primary focus of training is on research projects and fellows also complete the remaining seven months of their 18 month clinical requirement. This will include core rotations as described above, as well as rotations with the surgical critical care, thoracic and neurologic critical care teams.

Research Experience

Research Experience

The goal of the division’s research training is to allow fellows to pursue a project in their area of interest while providing them with a high quality experience that fosters intellectual development. We are committed to providing whatever support is necessary to allow our fellow to be successful in their research careers.

First Year

The research training process begins approximately in January of the first year which is a designated research month. First year fellows:

Meet with the program director to discuss their research interests

Review the potential projects submitted by faculty mentors, both inside and outside of the division, which are housed on the shared drive in a designated pulmonary research folder

Arrange to meet with various faculty to discuss potential projects and have serial meetings with the program director until reaching a decision on what project and mentor they wish to choose

Rank their choices of desired projects

Mentors rank their choices of fellows and the Fellowship Committee reviews these lists to ensure an optimal "match" of fellow to mentor. Once a primary mentor is chosen, the fellow is also assigned two additional mentor-level faculty who with the primary mentor compose a mentor panel for that fellow. The fellow meets with this panel at least quarterly during years two and three to review their research progress and to offer advice to facilitate their research project.

The fellows’ actual research experience (time) will begin in the second year. First year fellows are not expected to do any research. First year fellows are expected to submit one clinical manuscript during their first year.

Second Year

The goal of the second year is for fellows to develop a project and obtain preliminary data with the goal of presenting at a national conference, such as the ATS, ACCP, FASEB or SCCM.

At the beginning of this year, fellows and their mentors develop the fellow’s research project. During this time fellows begin to learn the various techniques involved particularly required basic science laboratory techniques.

Clinical research

For fellows pursuing clinical research, OSU has a formal training program for clinical research. The program consists of didactic course work integrated with a research project. At the conclusion of the two-year program, fellows will receive a Masters in Clinical Research and are expected to have written a research grant. There is also a clinical research MPH program that may be better suited for some fellow’s research projects.

All F2 fellows will take some graduate level courses in clinical research, such as statistics, clinical trial study design, ethics, etc.

Third Year

The major goal of the third year research experience is to help the fellow make career decisions and aid in their career preparation.

During the third year, fellows continue work on their ongoing research projects with the expectation of presenting their continuing results at national conferences and completing a manuscript.

All fellows are expected to have one or more research publications during their fellowship. Fellows are also expected to write a research grant during their third year regardless of whether they are in basic science or clinical research.

Our division has a T-32 training award from the NIH so there is the opportunity to fund fellows who may need additional time to complete their research proposals.

Training and Procedures

Training and Procedures

Our Critical Care Training program offers the unique ability for fellows to experience caring for critically ill patients within various models of ICU structure. Training in pulmonary medicine occurs via several venues. Learn more about the programs below.

Critical Care Training

Critical care training is made up of a total of nine and a half months – six months in the MICU and three and a half months in the non-medical ICU. Our Critical Care Training Program offers the unique ability for fellows to experience caring for critically ill patients within various models of ICU structure.

Four 12-bed medical intensive care units:

Three general medical ICUs in University Hospital. Two of these units are staffed in the traditional academic model with an attending, a fellow, two residents, two interns and medical students. One of these units is staffed in a collaborative model with an attending, critical care nurse practitioners and occasional residents and students.

One ICU dedicated to the care of patients with hematologic and oncologic disorders in the James Cancer Hospital. This unit is staffed in a collaborative model with an attending, a fellow, critical care nurse practitioners and occasional residents and students.

Ohio State University East mixed ICU

18-bed mixed ICU, primarily staffed by hospitalists, one pulmonary or critical care faculty member and one fellow consulting on all MICU and CCU patients. The fellow gets to experience a wide range of critical care models which require different levels of involvement and team dynamics.

We also have monthly critical care ultrasound sessions in the ICU staffed by ER and pulmonary and critical care faculty which are intended to allow interested fellows to become proficient in all aspects of critical care ultrasound.
Non-medical ICU Training

Non-medical ICU training occurs via the following rotations:

F2s spend one month as part of the SICU CC team, caring for all surgical patients including trauma patients

F3s spend one half month caring for all post-operative cardiac patients in the ICU

F3s spend one half month caring for all critically ill neurologic patients in the neurologic ICU

Fellows also see surgical critical care patients in a consultative manner when on consult rotations at University Hospital and OSU East Hospital

The surgical critical care fellows also rotate in the fourth floor MICU as part of our cross-disciplinary training in critical care

Pulmonary Medicine Training

Training in pulmonary medicine occurs via several venues:

Inpatient pulmonary consult services

See approximately 800-900 consults per year

Includes all aspects of pulmonary consultative medicine

Two consult teams (one based in the James Cancer Hospital, one based in the Ross Heart Hospital) each with a faculty, fellow and 0-2 residents or students

The two consult teams alternate days of accepting new admissions from the University Hospital. The majority of the patients are pulmonary in nature but there are critical care consults and ventilator management for patients requiring mechanical ventilation on cardiology services in the Ross Heart Hospital, in the James Bone Marrow Transplant Unit and in the University Hospital Surgical Intensive Care Unit. We only provide consultative service for these ICUs and are not responsible for the primary care of these patients.

Through these experiences the fellow will be exposed to the entire spectrum of pulmonary procedures including:

The pulmonary and critical care consult service at OSU East provides exposure to a wide spectrum of pulmonary patients. OSU East is a secondary hospital with a combination of private practice services and traditional academic services. This experience exposes the fellow to a different patient population and healthcare system than OSU University Hospital.

Lung transplant and cystic fibrosis

All fellows spend two weeks during their first year rotating on the adult cystic fibrosis service at Nationwide Children’s Hospital. During this time, they attend all outpatient cystic fibrosis clinics and complete a core curriculum. Additional elective time is available during the F2 and or F3 year for those fellows who are interested.

All fellows spend one month on the lung transplant service. This is a combined inpatient and outpatient experience designed to encompass all aspects of care for this patient population. The fellows attend pre-transplant evaluation clinics, post-transplant clinics, round on the inpatient service and participate in all related procedures for the month. Additional elective time on this service or in the outpatient transplant clinic is available for those fellows who are interested.

Outpatient pulmonary medicine training

Training in outpatient pulmonary medicine occurs via fellow clinics which are located in the Martha Morehouse Medical Plaza. Fellows maintain a outpatient clinic one half day per week throughout their fellowship. Clinics are only cancelled during the non-medical ICU rotations in SICU, cardiac and thoracic surgery.

Fellows will have a continuity clinic in general pulmonary medicine for 23 months. In addition, they spend two weeks in their first year in the sleep medicine clinics. The final 12 months of clinic will be done in six month blocks in a variety of the sub-subspecialty clinics.

Fellows will choose which three sub-subspecialty clinics they wish to rotate through from the following programs:

Pulmonary hypertension

Pulmonary transplantation

Cystic fibrosis

TB

ILD

Lung cancer

COPD

Asthma

Sarcoid

Interventional pulmonary

Other programs that can be modified to the fellow’s interest

Procedures

Over the last several years, graduating fellows have performed approximately 250-300 bronchoscopic procedures including transbronchial biopsies, transbronchial needle aspirations and bronchoalveolar lavage, 10-20 chest tubes and 50+ intubations including use of glidescope and intubating bronchoscope, as well as thoracentesis and central venous catheters (both with and without ultrasound guidance).

Fellows assist and have the opportunity to become proficient in placement of percutaneous tracheotomies in the MICU. Fellows also have the opportunity to achieve competency in critical care ultrasound imaging.

How to Apply

Application Process

Prerequisites

MD or DO

Be eligible for an Ohio training certificate or permanent medical license

Have successfully completed three years of US postgraduate training by the time of entry into the fellowship program

Hold U.S. citizenship, permanent residency or current ECFMG certificate

We cannot support H1-B visas and preference will be given to US citizens or applicants with a Green Card due to the eligibility requirements of the T32

Application documents

The following is a list of the required documents necessary to complete the application for our Pulmonary and Critical Care Fellowship.

USMLE Step 1, 2, 3 or COMLEX Scores

A letter from your residency program director (submitted via ERAS)

Three reference letters (submitted via ERAS) – one must be from a pulmonary or critical care faculty member or pulmonary and critical care fellowship program director

A recent photograph of the applicant

Interviews

Interviews are conducted on Mondays, Tuesdays and Thursdays from 8 a.m. - 1 p.m., during the months of August through October. Invitations to the interview will be sent out the first week of August.

Divisional Conferences

Conferences and Benefits

There are several pulmonary and critical care specific conferences scheduled each week, which cover both clinical practice and research topics. All of the fellows attend these conferences.

Fellows must attend at least 70% of conferences over their three-year fellowship in order to be eligible for graduation. The overall goal of our conferences is to foster learning and engender discussion about topics pertinent to the practice of pulmonary, critical care and sleep medicine.

We strongly believe in teaching based on the principles of evidence-based medicine, defined as the integration of best research evidence with clinical expertise and patient values. Our conferences include the following:

Research Conference

The Research Conference will be held weekly on Monday or Tuesday.

This conference will include clinical, translational and basic science presentations by pulmonary, critical care, allergy and sleep faculty from OSU and visiting lecturers from outside institutions. Senior pulmonary, critical care and allergy fellows will also present their research project at this conference prior to graduation.

Fellows Case Conference

Fellows Case Conference will be held twice monthly on Monday or Tuesday. There will be conferences scheduled on alternate days depending on the schedule of other didactics. This conference will be given by two fellows and will include a case presentation and evidence based review of a clinical question.

MICU Ultrasound Rounds

This conference covers the use of ultrasound for evaluation of the critically ill patient, hemodynamic assessment, evaluation of pulmonary abnormalities and procedures. It will include hands-on evaluation of ICU patients.

Resident Chest Conference

The quarterly Resident Chest Conference is a fellow-led conference for the OSU internal medicine residents. F2s will give presentations outlining basic interpretation of CXR and CT chest imaging. Case-based questions will also be included in these presentations.

Pulmonary Conference

Pulmonary Conference is a multi-format conference organized by the chief fellow and program director. It involves a set series of rotating topics over a three-year period, conforming to the ACGME topic requirements. There are didactic lectures given on a variety of topics focused the clinical management of sub subspecialty patients. These will be given by faculty from the Division of Pulmonary, Critical Care and Sleep Medicine and other departments on the medical center campus. Topics in allergy, asthma, COPD, cystic fibrosis, interstitial lung disease, interventional pulmonology, lung cancer, pulmonary hypertension, pulmonary transplantation, sarcoid and sleep medicine will be covered.

Interstitial Lung Disease Case Conference

Interstitial Lung Disease Case Conference is a bi-montly multi-disciplinary case conference where imaging, pathology and general management of ILD patients are discussed. This conference is led by Dr. Allen (PCC), Dr. Shilo (pathology) and Dr. Ghosh (radiology).

Sarcoid Case Conference

Sarcoid Case Conference is a twice montly multi-disciplinary case conference where imaging, pathology and general management of sarcoidosis patients are discussed. This conference is led by chief fellows Dr. Crouser (PCC) or Dr. Amin (PCC), Dr. Shilo (pathology) and Dr. Ghosh (radiology).

More +

Journal Club

Wednesday’s Journal Club is organized by a selected fellow with a faculty mentor. Recent publications pertinent to pulmonary and critical care medicine are reviewed. The goal of this exercise is to teach fellows how to critically review research articles, and will utilize the JAMA criteria on reviewing the medical literature. Particular attention will be given to review of clinical trials in regard to study design and statistical analysis.

The fellows will be expected to learn the principles of study design, power analysis, statistical comparison of parametric and non-parametric measures, confidence intervals, relative risk and life table and survival analysis. The fellow will also gain experience in different methods of data presentation and the applicability of medical research to patient care.

Internal Medical Grand Rounds

Internal Medical Grand Rounds, held weekly, includes reviews of topics pertinent to both pulmonary and critical care medicine.

Pulmonary Noon Report

Pulmonary Noon Report is held intermittently throughout the year. It is an informal clinical conference where the fellows discuss current interesting cases being cared for on the consult/ICU service or in outpatient clinic. Specific management issues regarding difficult or interesting cases will be discussed. Faculty can also present cases for input or discussion.

Critical Care Conferences

The Friday Critical Care Conferences are organized by the chief fellow and involve a set series of rotating topics specified by the program director, and conforming to the ACGME topic requirements over a three year period.

There are didactic lectures given on a variety of topics given by faculty from both pulmonary and critical care, as well as other departments on the medical center campus. This is a joint lecture with surgical, anesthesia, and neuro critical care fellows.

Avi Cooper, MD Third year fellow

Bio: Avi Cooper was born in Atlanta, Georgia and moved to Boston, Massachusetts in high school. He attended Yeshiva University in New York City where he studied English literature and biology and graduated summa cum laude as valedictorian. He attended medical school at Harvard University where he was selected for a research fellowship through the Howard Hughes Medical Institute. He remained in Boston for his Internal Medicine residency at Beth Israel Deaconess Medical Center where he developed an interest in medical education and completed a clinician educator track. As a senior resident Avi was selected by his peers to receive the Lowell McGhee award for excellence in teaching and joined the Gold Humanism Honor Society. He came to The Ohio State University in 2016 for fellowship.

During fellowship he has helped develop a small group-based core curriculum for residents rotating in the MICU and is investigating techniques to help enhance the educational value of MICU rounds. Avi also served as the primary preceptor for a pre-clinical Ohio State medical student in his fellow's clinic for the Longitudinal Practice curriculum and received departmental recognition for his research into transitions in training from medical school to residency. He has co-authored a textbook chapter with Dr. McCallister on teaching pulmonary/critical care fellows and was awarded the Robert J. Fass Award for Outstanding Clinical Fellow from the Department of Medicine during his second year. He currently serves as an associate editor for the Journal of Graduate Medical Education. His clinical research interests center on the prevention of organ injury in sepsis.

Outside of medicine, Avi enjoys spending time with his wife and son, drinking good cold-brewed coffee, playing classical piano, and training for (short) triathlons.

Jennica Johns, MD Second year fellow

MD: The Ohio State University College of MedicineResidency program: The Ohio State University Wexner Medical CenterFellowship Program: The Ohio State University Wexner Medical Center (Hospice and Palliative Medicine)

Kevin Patterson, MD Second year fellow

MD: Michigan State College of Human MedicineResidency program: The Ohio State University Wexner Medical Center

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